PATHOLOGICAL SUBSTRATES FOR 1-1 2 VENTRICULAR REPAIR/

Background. The concept of ''one and a half ventricular repair'' relat es to situations where one ventricle is capable of pumping one half of the circulation while the, other ventricle is deemed inadequate and r equires off-loading by means of a shunt. The inadequate ventricle is u sually assigned the role of pumping the pulmonary circulation. The maj ority of hearts potentially amenable to this repair will have one larg e ventricle associated with a smaller and more-or-less rudimentary ven tricle. Methods. In this review, we focused on hearts in which the mor phologically left ventricle will continue to support the systemic circ ulation. Results. Among the hearts with univentricular atrioventricula r connections, a few cases of classic tricuspid atresia and cases of d ouble-inlet left ventricle coexisting with concordant ventriculoarteri al connections would be suitable for incorporating the right ventricle into the pulmonary circulation. This procedure may be feasible in som e cases of straddling and overriding tricuspid valve. Hearts with pulm onary atresia and intact ventricular septum display a wide range of si zes of the right ventricular cavity. Although biventricular repair is an option for those with good-sized cavities, patients with hypoplasti c right ventricles may be candidates for one and a half ventricular re pair. Conclusions. For the lesions reviewed, and many others, one and a half ventricular repair can be an option. (C) 1998 by The Society of Thoracic Surgeons.